Break All The Rules: What the Leading Health Systems Do Differently with Analytics and Data Warehousing
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The document discusses the transformative approach of leading health systems in analytics and data warehousing, emphasizing the role of culture, strategy, and execution in achieving success. It identifies key traits of effective healthcare leaders, including risk-taking, principled decision-making, and data-driven approaches, while providing examples of successful organizations like Intermountain Healthcare and Kaiser Permanente. The narrative centers around building a supportive environment for analytics that prioritizes continuous improvement and effective data utilization.
Break All The Rules: What the Leading Health Systems Do Differently with Analytics and Data Warehousing
- 1. Break All The Rules What the Leading Health Systems Do Differently with Analytics and Data Warehousing © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright
- 2. Health Catalyst’s Philosophy We educate, we don’t sell. An educated person decides what’s best for them to buy. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 2
- 3. © 2014 Health Catalyst www.healthcatalyst.com Overview & Context • Healthcare Data Warehousing Association Creative Commons Copyright (HDWA), 2001 • How do we create role models for analytic success in healthcare? • Can we recreate it? • Health Catalyst is the commercial manifestation of HDWA • Today’s webinar • What are the common traits of the leaders?
- 4. © 2014 Health Catalyst www.healthcatalyst.com • I was hoping for checklists, recipes and algorithms for Analytic Success Creative Commons Copyright • No such luck • It’s much squishier than that, but it’s still replicable • Today’s discussion will be more about intangible qualities of culture, leadership, and attitude
- 5. © 2014 Health Catalyst www.healthcatalyst.com It Starts With Culture Followed closely by strategy and execution Creative Commons Copyright
- 6. © 2014 Health Catalyst www.healthcatalyst.com Leaders Are Operating Consistently At Level 6.5 Creative Commons Copyright 6
- 7. © 2014 Health Catalyst www.healthcatalyst.com There Aren’t Many Leaders A Few Examples • Intermountain Health Care • Quietly, consistently, leading for 30+ years Creative Commons Copyright • Allina • Becoming the Intermountain of Minnesota • Kaiser • Per-capita prepayment and quality baked into its DNA • Geisinger • The mindset of Intermountain, the culture of Mayo 7
- 8. © 2014 Health Catalyst www.healthcatalyst.com Why Isn’t Everyone Doing It? Is it really that difficult or complex? Creative Commons Copyright 8
- 9. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Culture 9
- 10. outset fail. Agile and lean wins in data warehousing as in small businesses.” • “I believe the most important lesson I have (and still am) learning is to let imperfect but useful things lose into the wild.” permission” to their BI leaders to evaluate rules and precedents based on risk and motives.” © 2014 Health Catalyst www.healthcatalyst.com Asked Dear Friends… …What key pieces of advice should I emphasize? • “Be brave with data.” • “The teams that try to plan everything out from the • “…let it lose and iteratively refine…” • “…smart healthcare CIOs expect and “give Creative Commons Copyright 10 Thank you Eric Just, Steve Catmull, and Mike Doyle
- 11. How Do You Identify A “Leader”? • They balance the tension of care delivery, economic risk, affordability © 2014 Health Catalyst www.healthcatalyst.com Lead Past Competing Interests of care, and accessibility to care… all under one CEO Creative Commons Copyright Risk Takers • They take risks, on their own, with new care delivery models and population health… no government mandates required Consistently Principle-Driven • They do the right thing for patients and their communities, even at the risk of financial loss in a fee-for-service environment Data Trumps Ego & Anecdote • They have the courage to face the truth of data • Data drives their decisions, not anecdotes and hunches Motivate people through Mastery, Autonomy, and Purpose They recognize what motivates people and organizations 11
- 12. By accident or design, leaders practice this… Thank you, Daniel Pink © 2014 Health Catalyst www.healthcatalyst.com What Motivates People? Creative Commons Copyright 12 Nurture and encourage these… Be aware to avoid stepping on them…
- 13. Inherently positive motives as they affect behavior Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose Generally negative motives as they affect behavior © 2014 Health Catalyst www.healthcatalyst.com The Motives Behind Behavior Creative Commons Copyright 13 Enlightenment Peace Joy Love Reason Acceptance Willingness Neutrality Courage Pride Anger Desire Fear Grief Apathy Guilt Shame The Turning Point *-- Power vs. Force, Hawkins
- 14. Leading Past Competing Interests 14 Balance is elusive… it moves… and might not always be appropriate
- 15. 15
- 16. Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose © 2014 Health Catalyst www.healthcatalyst.com Leaders Are 100% Consistent On This… Creative Commons Copyright 16
- 17. Simple Equation Leaders are constantly thinking in these terms, and living in the realm of risk tolerance © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 17 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 18. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Data Quality 18 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 19. © 2014 Health Catalyst www.healthcatalyst.com Trust With Data Creative Commons Copyright 19 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 20. © 2014 Health Catalyst www.healthcatalyst.com Centralized vs. Decentralized Resources and Staffing Creative Commons Copyright 20 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 21. Determination & Commitment 21 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 22. © 2014 Health Catalyst www.healthcatalyst.com Internal Small Business Mentality Creative Commons Copyright 22 Nobody has to do business with the EDW team
- 23. © 2014 Health Catalyst www.healthcatalyst.com Characteristics of Successful Small Businesses Creative Commons Copyright 23
- 24. Small Business Checklist 1. Have you clearly documented your products and services AND the customers that want/need them? 2. Do you have product line managers and teams? 3. Do you track who uses which of your products and how often? 4. Do you have a strategic product roadmap? 5. Do you have a web site that makes it easy… ‒ For new customers to find you, understand your products, and consume them? ‒ For existing customers to get the most out of your products and encourage those customers to collaborate? 6. Do you have a team member that leads and executes your marketing strategy to attract new clients? 7. Are you operating with financial efficiency? 8. Do you regularly poll your customers for their satisfaction and suggestions for product enhancements? 9. Do you regularly poll your team members to track their satisfaction? 10. Do you have a Board of Directors (i.e., Data Governance Committee)? 24
- 25. © 2014 Health Catalyst www.healthcatalyst.com Personality Of The Analytics Leader Creative Commons Copyright 25 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 26. © 2014 Health Catalyst www.healthcatalyst.com Personality Of The Analytics Team Creative Commons Copyright 26 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 27. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Strategy 27
- 28. Leaders Are Covering The Continuum Of Analytic Use Cases 28 Robert Wood Johnson Foundation, 2014 Requires a collaborative strategy between leaders in healthcare, politics, charity, education, and business Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 29. They Invest In Analytics • This is not an “additional duty” • EMRs required investments in technology and people… so do enterprise data warehouses (EDW). But, luckily, a small fraction of an EMR. 29 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 30. The EMR Is A Means, Not The End © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 30 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 31. © 2014 Health Catalyst www.healthcatalyst.com Where Are They Focused? Creative Commons Copyright 31 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 32. Aligning Strategy: Data to Monitor Variation Range 85% - 95% Range 94% - 98% The Joint Commission Index Across Hospitals: Demonstrated Progress in Reducing Variation Thank you, Lisa Shilling, Kaiser Permanente
- 33. © 2014 Health Catalyst www.healthcatalyst.com Analytics Strategy Vertical and Horizontal… Tactical and Strategic Primary Care Women & Newborns Intensive Medicine Cardiology Oncology Creative Commons Copyright 33 Lab Admissions Radiology Registration Pharmacy Nursing AR/AP Materials Mgt Step Two: Clinical Excellence Programs Step One: Operational Excellence Programs More complex Less complex
- 34. Organize Your Analytics Teams © 2014 Health Catalyst www.healthcatalyst.com Boards and C-Levels: Let your clinical and administrative leaders establish their specific clinical and financial goals Creative Commons Copyright 34
- 35. © 2014 Health Catalyst www.healthcatalyst.com Matrixed Collaboration Creative Commons Copyright 35
- 36. © 2014 Health Catalyst www.healthcatalyst.com Move On Parallel Fronts Creative Commons Copyright 36
- 37. Replacing Existing Reporting Systems Use the EDW for its unique capabilities… stop squabbling with the Departments © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 37 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 38. Analytics Tools Dogma There’s a reason Excel is still so popular… it works Give data analysts what they want; not what you want them to want © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 38 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 39. • Can you define all the use cases for the books in a library? No… same is true for a data warehouse data in its true form, you can repurpose that data, an infinite number of ways © 2014 Health Catalyst www.healthcatalyst.com Traditional Software Engineering vs. Data Engineering • The thickness of a requirements document is inversely related to the success of a data warehousing project • As long as you gather and retain the granular Creative Commons Copyright 39 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 40. © 2014 Health Catalyst www.healthcatalyst.com The Data Warehouse Platform… It’s Not Just For Analytics Secondary Use of Transaction Data Creative Commons Copyright 40 Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
- 41. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Execution 41
- 42. Geisinger Managing gaps in care Lipid Panel, HgbA1c Lab Result Imaging Result Clinical Goal BP <140/90, LDL <100 Aspirin for CAD 42 42 Care Gap Examples Advance Directives Depression and Asthma Active Medication Scanned Document Patient Reported Data Mammogram, DXA Nephrology for CKD Stage 4 Referral Diagnosis Coding HCCs Patient Education Heart Failure Asthma Action Plan Clinical Documentation Thank you, Dr. Fred Bloom
- 43. Geisinger Redesign and Care Coordination Delivers Rapid Impact Thank you, Dr. Fred Bloom 43 43
- 44. Care Gap Programs Thank you, Dr. Fred Bloom AAA Screening Malignant Melanoma Adolescent Well Visits— Birthday Model Medical Weight Management Adult Preventive Care— Birthday Model Osteoporosis Program Colonoscopy Screening Program—Birthday Model Peds Transition to Primary Care (after age 18) CKD Stage 4 Sleep Medicine Outreach (BMI 35-39) Dexa Scans Women’s Health: Annual GYN Exams—Birthday Model Emergency Department Transition to Primary Care Provider Influenza, Pertussis & Pneumococcal 44
- 45. Proven Health Navigator Results for Medicare Thank you, Dr. Fred Bloom 45 (Am J Manag Care. 2010;16(8):607-614)
- 46. PHN Return On Investment Thank you, Dr. Fred Bloom 46
- 47. Three-Year Results in 25,000 DM Patients Thank you, Dr. Fred Bloom 47 305 MIs Prevented NNT to prevent one (1) MI = 82 patients 140 Strokes Prevented NNT to prevent one (1) Stroke = 170 patients 166 Cases of Retinopathy Prevented NNT to prevent one (1) case of Retinopathy = 152 patients
- 48. Kaiser’s Quality Goals Timeline – 2011 – 2013 Domain 2011 2012 2013 Population Health Self perceived health status data for 15% of members Self perceived health status data for 20% of members Self perceived health status data for 25% of members Population Care Management - Chronic Conditions Medicare Stars Part C 4 Stars HEDIS composite at 90th percentile All CV, diabetes, and cancer screening metrics at 90th percentile Behaviorial Health, Musculoskeletal 90% Medication Management 75% Medicare Stars Part C 4 Stars All CV, diabetes, and cancer screening metrics at 90th percentile Behaviorial Health, Musculoskeletal and respiratory @ 90% Medication Management 75% Medicare Stars Part C 4 Stars All CV, diabetes, and cancer screening metrics at 90th percentile Behaviorial Health, Musculoskeletal and respiratory @ 90% Medication Management 90% Inpatient HSMR TJC Composite Reduce HSMR: Below US Medicare average, crude mortality 10% from 2010 baseline TJC Composite at national 90th percentile Readmit rate<15% of all cause readmissions Reduce HSMR: Below US Medicare TBD - May shift to inpatient outcomes Readmit rate<10% of all cause readmissions TJC Composite at national 90th percentile Reduce HSMR: Below US Medicare TJC Composite at national 90th percentile Patient Safety Never Events 10% less events than 2010 10% less events than 2011 10% less events than 2012 Workplace Safety Per regional targets Per regional targets Per regional targets Clinical Risk Management 0 to 5% reduction in lawsuits with a payout from 2010 0 to 5% reduction in lawsuits with a payout from 2011 0 to 5% reduction in lawsuits with a payout from 2012 Service Hospital Outpatient HealthPlan Medicare Stars At National 75th percentile (final quarter) 75th percentile in local or national in 3 of 8 regions 75th percentile in local or national in 6 of 8 regions 4 Stars on Overall CAHPS At national 75th percentile (rolling 12 months) 75th percentile in local or national in 5 of 8 regions 75th percentile in local or national 7 of 8 regions 4+ Stars on Overall CAHPS Above National 75th percentile (rolling 12 months) 8 of 8 Regions at goal 8 of 8 regions at goal 4+ Stars on Overall CAHPS Equitable Care Identify interventions to reduce the gap Decrease the gap by x% Decrease by x% more over 2012 Thank you, Lisa Shilling, Kaiser Permanente
- 49. Thank you, Intermountain web site © 2014 Health Catalyst www.healthcatalyst.com Intermountain’s Board Goals Six “Dimensions of Care” goal areas 1. Clinical Excellence 2. Patient Engagement 3. Operational Effectiveness 4. Employee Engagement 5. Physician Engagement 6. Community Stewardship Creative Commons Copyright 49
- 50. Intermountain’s Clinical Excellence Board Goals 1. Behavioral Health Clinical Program: Decrease inpatient psychiatric 30-day readmission rate for the Intermountain system. 2. Cardiovascular Clinical Program: Integrate the treatment of heart failure patients across the continuum to improve care and reduce hospital readmissions. 3. Intermountain Homecare: Improve care transitions to and from Homecare through effective communication, collaboration, and coordination among care providers. 4. Intensive Medicine Clinical Program: Decrease mortality in patients diagnosed during their hospital stay with severe sepsis. 5. Oncology Clinical Program: Improve the appropriate utilization of genetic screening to determine if families are at higher risk for colon and endometrial cancer. 6. Patient Safety: Reduce the system rate of catheter-associated urinary tract infections. 7. Pediatric Specialties Clinical Program: Build a care model for children with type 1 diabetes. 8. Primary Care Clinical Program: Establish an individualized approach to diabetic care by engaging patients in self-management, primary care visits, and specialty consultations. 9. SelectHealth: Increase the percentage of SelectHealth members with diabetes who meet four measures of diabetes care: blood sugar control, cholesterol control, kidney function, and eye exam. 10. Surgical Services: A three-part goal that reduces blood utilization, defines clinical outcome measures for specific development teams, and develops and implements a standardized process to decrease intracase supply utilization. Intracase utilization means the processes or units of care used within each health episode. 11. Women and Newborns: Improve care, cost efficiency, and resource utilization in the neonatal intensive care unit (NICU), and accurately estimate the number of babies with early onset bacterial infection. 12. Primary Children’s Hospital: Increase the involvement of infectious disease specialists in decisions to use outpatient antibiotic therapy via infusion, injection, or implantation. 13. Rural Facilities: Implement electronic physician orders to guide evidence-based care for patients with the primary diagnosis of pneumonia, labor induction, pancreatitis, and sepsis. 14. CMS Value-Based Purchasing: The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards hospitals with incentive payments for the quality of care they provide to people covered by Medicare. The focuses for Intermountain’s goal in this area are to: ● Attain a significant improvement in the value-based purchasing process and outcome domains for select measures. ● Sustain progress for those hospitals that already meet or exceed national benchmarks. Thank you, Int5e0rmountain web site
- 51. In Conclusion © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 51
- 52. How Do You Become An Analytics “Leader”? • Balance the tension of care delivery, economic risk, affordability of © 2014 Health Catalyst www.healthcatalyst.com Lead Past Competing Interests care, and accessibility to care… all under one CEO Creative Commons Copyright Take Risk • Take risks, on their own, with new care delivery models and population health… no government mandates required Consistently Practice Principle-Driven Decisions • Do the right thing for patients and their communities, even at the risk of financial loss in a fee-for-service environment Value Data Over Ego & Anecdote • Have the courage to face the truth of data • Data drives their decisions, not anecdotes and hunches Motivate through Mastery, Autonomy, and Purpose • Recognize what motivates people and organizations 52
- 53. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Thank You Upcoming Educational Opportunities Healthcare Transformation Series: Chapter Seven Date: September 4, 1-2pm, EST Presenter: Dr. John Haughom, Senior Advisor, Health Catalyst http://www.healthcatalyst.com/knowledge-center/webinars-presentations Healthcare Analytics Summit Join top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs. Date: September 24th-25th Location: Salt Lake City, Utah Save the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014
- 54. Transforming Healthcare Through Analytics Billy Beane General Manager Oakland A’s Glen D. Steele, MD, PhD President and CEO Geisinger Health System Ray Kurzweil Director of Engineering Google and Leading Futurist James Merlino, MD Chief Experience Officer Cleveland Clinic Creative Commons Copyright © 2014 Health Catalyst © 2014 Health Catalyst www.healthcatalyst.com www.healthcatalyst.com Provide a tangible vision of healthcare analytics Leading keynote speakers Engage the audience with analytics in a unique way Hands-on learning experiences Interactive audience engagement, optimized for teams User and special interest group follow up Provide meaningful networking opportunities Share Health Catalyst vision, products, roadmaps Have Fun Access to a mobile app will be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics. hasummit.com Penny Wheeler President and Chief Clinical Officer Allina Health Charles Macias, MD, MPH Chief Clinical Integration Systems Office Texas Children’s Hospital Governor Mike Leavitt Former Secretary of HHS Founder of Leavitt Partners Ms. Lizette Yearwood, JP Chief Executive Officer Cayman Islands Health Service Authority (HAS) Keynote Speakers
- 55. © 2014 Health Catalyst www.healthcatalyst.com Q&A, Contact Information dale.sanders@healthcatalyst.com Creative Commons Copyright @drsanders 55